Gout in Childhood and Adolescence
Gout is a form of joint swelling (arthritis), which typically
occurs in the big toe, foot, ankle, or knee. A gout attack usually begins with
quite severe pain in one of these joints. The pain can be so severe that the
person cannot even have a bed sheet touching the joint. The joint is often hot
and swollen. Over several days to a week, the pain from the gout often improves
and goes away, but gout will often occur again.
Gout is caused by elevated blood uric acid levels. Uric acid can
build up due to increased intake or production of uric acid or due to the
decreased removal of uric acid by the kidneys. Sometimes excessive intake of
substances containing uric acid can lead to gout.
Many people think of gout being caused by excess intake of beer,
alcohol, meat, and shellfish. While these may cause a gout attack to occur,
there are usually other reasons that individuals have gout. These factors are
usually NOT the causes of gout in children and teenagers.
If a child or teenager has gout, it is important that blood and
urine tests be done to determine why gout has occurred. It is usually a sign of
an underlying problem that is often easily treated.
In children, the first test to do if gout is suspected is to
measure the blood uric acid level. If
this is elevated (>6), this could be a sign that gout is present. Other important procedures are for a doctor
to insert a needle into the affected joint, withdraw fluid, and examine this
fluid for uric acid crystals.
Causes of gout in children and teenagers include:
conditions that cause over-production of uric acid. These include HPRT
deficiency (also known as Lesch Nyhan syndrome) and PRPP synthetase overactivity.
These disorders are uncommon but are easily tested for. Patients produce extra
uric acid and can have gout and kidney stones containing uric acid. These
conditions usually occur in boys but can occasionally happen in girls as
diseases resulting in decreased ability of the body to get rid of uric acid.
There are several types:
a. The most common type is due to mutations in the gene
that produces a protein called uromodulin. In this condition, patients develop
gout in their teenage years and have slow worsening of kidney failure over
time. There are usually many other family members who have had gout or kidney
b. Another cause of this condition is a mutation in the
gene that makes the protein renin. In this condition, children have a history
of relatively low blood pressure, anemia (low blood count), and mild kidney
disease. The blood potassium levels are often mildly elevated. The anemia is
present from the time the child is young, and often the cause of the anemia is
not known. This condition is easily diagnosed and treatable with medications.
Patients with this condition often have a father or mother who has gout, anemia
as a child, and kidney disease.
c. Any type of kidney disease can also cause gout in
3. Patients who are
overweight and have high blood pressure can also be at risk for gout. This
usually occurs in the 20’s and 30’s, but it is becoming more common in young
individuals. This is called Metabolic Syndrome.
If you have a child that you believe may have gout or has been diagnosed
with gout, please contact Dr. Bleyer. He
can help advise on further testing.
Dr. Anthony Bleyer at Wake Forest School of Medicine conducts research into the causes of gout in childhood.
If you have any questions, please contact Dr. Bleyer at 336-716-4513 or email at firstname.lastname@example.org.